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Can a Low Stem Cause Knee Pain?

Question: I lowered my stem slightly after 18 months of riding in the same position. Immediately I felt knee pain on my usual 20-mile lunch ride. Coincidence, or did the stem change cause it? If it did, is there some other adjustment I should make to compensate, like lowering my saddle? — Mike P.

Coach Fred Matheny Replies: The lower stem might be the culprit, or you may have developed a touch of tendinitis independent of that alteration. But the general rule is to suspect a position change when you get injured in the absence of major increases in distance or intensity.

Lowering your stem puts more pressure on the hamstrings and lower back because they’re connected. They act like a taut bowstring as you lean forward to the handlebar. A lower stem can also impact the front of the knees because your hip/chest angle is tighter. In effect, knees bend more at the top of the stroke.

It’s unlikely that yet another change in your position will compensate for the lower stem. In fact, lowering your saddle is more likely to cause a different problem, most likely involving your knees, too. I recommend returning the stem to its original height to see if your knee feels better.

The aero advantage of a low handlebar is overrated. If you can’t ride your bike without discomfort, you won’t realize the few seconds per mile that better aerodynamics can subtract. Even with a higher bar position, you can always get aero when you need to. Just bend your elbows!